Last update: December 19, 2025
Brixadi is the first and only long-acting buprenorphine injection that offers both weekly and monthly dosing options for treating opioid use disorder. Approved by the FDA in May 2023, it works by releasing medication steadily into your body over weeks, eliminating the need for daily pills while reducing cravings and preventing withdrawal.
Brixadi (buprenorphine extended-release injection) is a medication used to treat moderate to severe opioid use disorder. It contains the same active ingredient as Suboxone—buprenorphine—but delivers it through a once-weekly or once-monthly injection instead of daily pills or films.
When a healthcare provider injects Brixadi under your skin, it forms a small gel deposit that slowly releases buprenorphine over time. This creates stable medication levels in your body, which helps control cravings and prevents withdrawal symptoms without the daily ups and downs of taking pills.
The medication works on the same brain receptors as other opioids but in a safer way. It reduces cravings and blocks the effects of other opioids while having a "ceiling effect" that limits dangerous side effects like slowed breathing.
Brixadi comes in seven different strengths to match your treatment needs:
Weekly injections:
Monthly injections:
Your doctor will determine which strength and schedule works best based on your current treatment and individual needs.
Clinical research shows Brixadi works as well as daily Suboxone pills—and may work even better for some people.
A major study published in JAMA Internal Medicine followed 428 adults with opioid use disorder for 24 weeks. Researchers compared Brixadi injections to daily sublingual buprenorphine (Suboxone) and found:
The study included real-world patients—26% tested positive for fentanyl at the start, 71% were using heroin, and 38% had hepatitis C. This means the results apply to people facing the actual challenges of recovery today.
Brixadi is approved for adults with moderate to severe opioid use disorder who meet specific requirements.
The FDA requires that only certified healthcare providers can give Brixadi injections. You cannot take this medication home or inject it yourself. This requirement exists because self-injection, especially into a vein, can cause serious complications.
Starting Brixadi requires working with a certified treatment provider and following a specific process.
If you're not already taking buprenorphine, you'll need to start with a test dose. Your doctor will:
Once the test dose goes well, you can receive your first Brixadi injection. Most people start with:
Your doctor will adjust your dose based on how you respond. If you're switching from daily Suboxone, your Brixadi dose depends on how much you currently take:
Daily Suboxone Dose
Weekly Brixadi
Monthly Brixadi
Up to 6mg
8mg weekly
Not recommended
8-10mg
16mg weekly
64mg monthly
12-16mg
24mg weekly
96mg monthly
18-24mg
32mg weekly
128mg monthly
Most people start with weekly injections before moving to monthly dosing. This allows your doctor to fine-tune your treatment more easily.
Brixadi causes side effects similar to other buprenorphine medications, plus some reactions at the injection site.
Most injection site reactions are mild and go away on their own. Serious reactions like abscesses or skin breakdown are rare and usually happen when the injection isn't given correctly.
Breathing problems: Taking Brixadi with benzodiazepines (like Xanax or Valium), alcohol, or other sedatives can slow your breathing dangerously. However, doctors recognize that many people in recovery take these medications, and the benefits of continuing Brixadi usually outweigh the risks.
Liver problems: Buprenorphine can affect liver function. Your doctor will check your liver with blood tests before starting treatment and periodically while you take Brixadi.
Withdrawal symptoms: If you stop Brixadi suddenly, you may experience withdrawal. The medication stays in your system for weeks after your last injection, which helps reduce withdrawal compared to stopping daily medication.
Brixadi is significantly more expensive than generic daily buprenorphine, but insurance and assistance programs can help.
For comparison:
Medicaid: Many state Medicaid programs cover Brixadi with copays as low as $4-$8, though 37% require prior authorization from your doctor.
Commercial insurance: About 88% of commercial insurance plans provide some coverage for injectable buprenorphine, but most require prior authorization.
Medicare: Coverage varies widely. Only 19% of Medicare Advantage plans covered long-acting buprenorphine as of recent data, making this the most challenging insurance to use.
Brixadi Copay Savings Program: If you have commercial insurance, you may qualify to pay $0 per injection. Visit the Brixadi website or call 877-279-7367 to check eligibility.
Braeburn ByYourSide Program: Provides help navigating insurance, filing appeals, and finding financial assistance.
Note: Federal law prohibits manufacturer copay assistance for Medicare, Medicaid, VA, and other government insurance programs.
Understanding how Brixadi differs from other options helps you and your doctor choose the best treatment.
Similarities:
Brixadi advantages:
Suboxone advantages:
Both are monthly buprenorphine injections with similar effectiveness. Key differences:
Brixadi offers:
Sublocade offers:
Methadone advantages:
Brixadi advantages:
Research shows that high-dose buprenorphine (16mg or more) works as well as methadone for most people. The best choice depends on your individual situation, treatment history, and preferences.
Because of safety requirements, Brixadi is only available through certified healthcare facilities—not regular pharmacies.
Certified addiction treatment centers: Specialized clinics that treat opioid use disorder often offer Brixadi alongside other treatment options.
Healthcare systems: Some hospitals and health systems have addiction medicine programs certified to provide Brixadi.
Telehealth providers: While Brixadi injections must be given in person, some telehealth services like Bicycle Health coordinate local injection sites for their virtual patients.
Provider search: The SAMHSA treatment locator (1-800-662-4357 or findtreatment.gov) can help you find certified providers in your area.
The MAT Act eliminated special requirements for prescribing buprenorphine as of December 2022. Any medical provider with DEA authority to prescribe controlled substances can now prescribe Brixadi without additional certifications or patient limits.
Brixadi offers a powerful new option for treating opioid use disorder, particularly if you:
The clinical evidence supports Brixadi's effectiveness, with zero overdose deaths reported in the main trial and superior drug-free test results compared to daily medication. The weekly dosing flexibility makes it unique among long-acting treatments.
However, cost and access remain significant barriers for many people. If insurance doesn't cover Brixadi or if you live far from a certified provider, daily Suboxone may be more practical despite requiring daily dosing.
At Bicycle Health, we help patients access the full range of medication-assisted treatment options, including daily buprenorphine, Sublocade, and Brixadi when appropriate. Our addiction medicine specialists can evaluate your situation and work with you to find the treatment approach that fits your life, your insurance, and your recovery goals.
Recovery from opioid use disorder is possible with the right treatment and support. If you're considering Brixadi or want to explore your medication options, schedule a virtual consultation with our team today.
